Sheet 1: PROCEDURE & INSTRUCTIONS

	
	
	

		

 
		
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
1115
Capital Project Number Request
		
	

		
	

		
	

		


		


		


		


		


		


		


		


		
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Form 1115 Capital Project Number Request is used by the Assistant Director of Project Management (ADPM), at Project Initiation,  to obtain both a Project Number for the proposed project and a CORE-CT Project Number for accounting purposes.  The form, except for spaces reserved for input by DAS Project Accounting, is to be completed in full and then forwarded by email to DAS Project Accounting for further processing.  The completed form will be returned by email to the ADPM.
		
	

		
	

		
	

		
	

		
	

		
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Instructions to ADPM:
		
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
The ADPM is to insert data in the light blue spaces only.
		
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
1
		
Insert Date of Request
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
2
		
Project Reference - make no entry in this space  unless DCS Fees are to be charged to other than project funds. 
		
	

		


		
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
3
		
Enter the Project Name
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
4
		
Enter the Agency Name and Agency Code in the spaces provided
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
5
		
Insert name of Town where project is to be located
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
6
		
Check the Type(s) of project construction
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
7
		
Enter the Assistant Director of Project Management (ADPM)'s Name
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
8
		
Insert the Total Project Cost
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
9
		
Insert the Estimated Construction Cost
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
10
		
Insert the Estimated DCS Fees
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
11
		
Enter the Bond Act Section Number and the Amount bonded in the spaces provided
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
12
		
Enter other Funding Sources & Amounts in the spaces provided
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
13
		
Email the form as an attachment to Glenn Knapsack, DAS Project Accounting: 
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
glenn.knapsack@ct.gov
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
14
		
File the completed Form 1115 in "File Folder G1"